Opioid Workforce Act of 2018
This bill increases the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have addiction or pain management programs, with an aggregate increase of 1,000 positions over a five-year period.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5818 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5818
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions to help combat the
opioid crisis.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 15, 2018
Mr. Crowley (for himself and Mr. Costello of Pennsylvania) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Energy and Commerce, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions to help combat the
opioid crisis.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Opioid Workforce Act of 2018''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO HELP COMBAT
OPIOID CRISIS.
(a) In General.--Section 1886(h) of the Social Security Act (42
U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)(F)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(3) in paragraph (7)(E), by inserting ``paragraph (9),''
after ``paragraph (8),''; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions to
help combat opioid crisis.--
``(A) Additional residency positions.--For each of
fiscal years 2019 through 2023 (and succeeding fiscal
years if the Secretary determines that there are
additional residency positions available to distribute
under subparagraph (D)), the Secretary shall increase
the otherwise applicable resident limit for each
qualifying hospital that submits a timely application
under this subparagraph by such number as the Secretary
may approve for portions of cost reporting periods
occurring on or after July 1 of the fiscal year of the
increase. Except as provided in subparagraph (B)(iv) or
(D), the aggregate number of increases in the otherwise
applicable resident limit under this subparagraph shall
be equal to 500 in fiscal year 2019 and 500 over the
period of fiscal years 2020 through 2023, distributed
in accordance with the succeeding subparagraphs of this
paragraph.
``(B) Distribution for fiscal year 2019.--
``(i) In general.--For fiscal year 2019,
the positions available for distribution with
respect to the fiscal year as described in
subparagraph (A) shall be distributed to
hospitals that have existing established
approved programs in addiction medicine,
addiction psychiatry, or pain management as
determined by the Secretary.
``(ii) Number of positions hospital
eligible to receive.--Subject to clauses (iii)
and (iv), the aggregate number of positions a
hospital may receive under this subparagraph
with respect to fiscal year 2019 is equal to
the sum of the following:
``(I) The number of full-time-
equivalent residents that will be
training in addiction medicine,
addiction psychiatry, or pain
management as determined by the
Secretary with respect to the fiscal
year.
``(II) The associated number of
residents training in a pre-requisite
program, such as internal medicine,
necessary for the number of full-time
residents for the programs described in
subclause (I).
``(iii) Additional positions for expansion
of existing program.--If a hospital
demonstrates to the Secretary that the hospital
is planning to increase the number of full-
time-equivalent residents in existing programs
described in clause (i), the Secretary may
increase the number of positions a hospital is
eligible to receive under clause (ii) in order
to accommodate that expansion, as determined by
the Secretary.
``(iv) Considerations in distribution.--The
Secretary shall distribute additional residency
positions under this subparagraph based on--
``(I) in the case of positions made
available under clause (ii), the
demonstrated likelihood of the hospital
filling such positions by July 1, 2019;
and
``(II) in the case of positions
made available under clause (iii), the
demonstrated likelihood of the hospital
filling such positions within the first
three cost reporting periods beginning
on or after July 1, 2019.
``(v) Limitation.--Notwithstanding clauses
(ii) and (iv), an individual hospital may not
receive more than 25 full-time-equivalent
residency positions under this subparagraph.
``(vi) Clarification regarding availability
of additional positions in subsequent fiscal
years.--Nothing in this subparagraph shall
preclude a hospital from receiving additional
residency positions under subparagraph (C).
``(vii) Positions not distributed during
the fiscal year.--If the number of resident
full-time-equivalent positions distributed
under this subparagraph is less than the
aggregate number of positions available for
distribution in the fiscal year (as described
in subparagraph (A)), the difference between
such number distributed and such number
available for distribution shall be added to
the aggregate number of positions available for
distribution under subparagraph (C).
``(C) Distribution for fiscal years 2020 through
2023.--
``(i) In general.--For the period of fiscal
years 2020 through 2023, the positions
available for distribution with respect to such
period (as described in subparagraph (A),
including after application of subparagraph
(B)(vi)) shall be distributed to hospitals
which demonstrate to the Secretary that the
hospital--
``(I) will establish an approved
program in addiction medicine,
addiction psychiatry, or pain
management; and
``(II) will use all of the
additional positions made available
under this subparagraph in such program
or a prerequisite residency program for
such program within the first four cost
reporting periods after the increase
would be effective.
``(ii) Requirements.--Subject to clause
(iii), a hospital that receives an increase in
the otherwise applicable resident limit under
this subparagraph shall ensure, during the 5-
year period beginning after the date of such
increase, that the hospital uses the positions
received under clauses (i)(I) and (i)(II) for
the programs for which the positions were
distributed, or similar programs (as determined
by the Secretary). The Secretary may determine
whether a hospital has met the requirements
under this clause during such 5-year period in
such manner and at such time as the Secretary
determines appropriate, including at the end of
such 5-year period.
``(iii) Redistribution of positions if
hospital no longer meets certain
requirements.--In the case where the Secretary
determines that a hospital described in clause
(ii) does not meet the requirements of such
clause, the Secretary shall--
``(I) reduce the otherwise
applicable resident limit of the
hospital by the amount by which such
limit was increased under this
subparagraph; and
``(II) provide for the distribution
of positions attributable to such
reduction in accordance with the
requirements of this paragraph.
``(iv) Limitation.--An individual hospital
may not receive more than 25 full-time-
equivalent residency positions under this
subparagraph.
``(D) Distribution of remaining positions.--If the
aggregate number of positions distributed under
subparagraphs (B) and (C) during the period of fiscal
years 2019 through 2023 is less than 1,000, the
Secretary shall distribute the remaining residency
positions in succeeding fiscal years according to
criteria consistent with this paragraph until such time
as the aggregate amount of positions distributed under
this paragraph is equal to 1,000.
``(E) Notification.--The Secretary shall notify
hospitals of the number of positions distributed to the
hospital under this paragraph as a result on an
increase in the otherwise applicable resident limit by
January 1 of the fiscal year of the increase. Such
increase shall be effective for portions of cost
reporting periods beginning on or after July 1 of that
fiscal year.
``(F) Application of per resident amounts for
primary care and nonprimary care.--With respect to
additional residency positions in a hospital
attributable to the increase provided under this
paragraph, the approved FTE per resident amounts are
deemed to be equal to the hospital per resident amounts
for primary care and nonprimary care computed under
paragraph (2)(D) for that hospital.
``(G) Permitting facilities to apply aggregation
rules.--The Secretary shall permit hospitals receiving
additional residency positions attributable to the
increase provided under this paragraph to, beginning in
the fifth year after the effective date of such
increase, apply such positions to the limitation amount
under paragraph (4)(F) that may be aggregated pursuant
to paragraph (4)(H) among members of the same
affiliated group.
``(H) Definitions.--In this paragraph:
``(i) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under subparagraphs
(F)(i) and (H) of paragraph (4) on the resident
level for the hospital determined without
regard to this paragraph but taking into
account paragraphs (7)(A), (7)(B), (8)(A), and
(8)(B).
``(ii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).''.
(b) IME.--
(1) In general.--Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the third
sentence, is amended by striking ``and (h)(8)'' and inserting
``(h)(8), and (h)(9)''.
(2) Conforming provision.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
(A) by redesignating clause (x), as added by
section 5505(b) of the Patient Protection and
Affordable Care Act (Public Law 111-148), as clause
(xi) and moving such clause 4 ems to the left; and
(B) by adding after clause (xi), as redesignated by
subparagraph (A), the following new clause:
``(xii) For discharges occurring on or after July 1, 2019,
insofar as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(9), the indirect teaching adjustment
factor shall be computed in the same manner as provided under
clause (ii) with respect to such resident positions.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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